Cefuroxime as Treatment for Leptospirosis

• Based on most guidelines, only 3^rd generation cephalosporins are indicated for treatment of Leptospirosis
• No pharmacological reasoning for the selection based on literature review.
• The only available reason is the efficacy of first generation cephalosporins has been less well-studied.
• Studies
• No studies have been carries out using Cefuroxime

In Vitro and In Vivo Activity of First Generation Cephalosporins AgainstLeptospira. Am J Trop Med Hyg. 2011 Nov 1; 85(5): 905–908

• Efficacy of cefazolin and cephalexin in an acute lethal hamster model of leptospirosis was studied.
• Survival rates for cefazolin were 80%, 100%, and 100%, and survival rates for cephalexin were 50%, 80%, and 100% (treated with 5, 25, and 50 mg/kg per day for 5 days, respectively).
• Each treatment group showed improved survival compared with no treatment (P < 0.01)

Alexander AD, Rule PL. Penicillins, cephalosporins, and tetracyclines in treatment of hamsters with fatal leptospirosis. Antimicrob Agents Chemother. 1986;30:835–839

• first generation cephalosporins (cefadroxil and cephalexin), even in high doses, were not shown to be effective against leptospirosis in their hamster model. 
• Their work did show a survival benefit for second (cefamandole) and third (cefoperazone, cefotaxime, and moxalactam) generation cephalosporin

References:

1. http://www.moh.gov.my/images/gallery/Garispanduan/GL_Leptospirosis%202011
2. http://www.who.int/zoonoses/diseases/Leptospirosissurveillance
3. http://bestpractice.bmj.com/best-practice/monograph/913/treatment/step-by-step.html